Provider Demographics
NPI:1427542133
Name:LEPAK, MARIA ANGELA (BA)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:ANGELA
Last Name:LEPAK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 SUSIE CT
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54173-8464
Mailing Address - Country:US
Mailing Address - Phone:920-434-3413
Mailing Address - Fax:
Practice Address - Street 1:2045 SUSIE CT
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54173-8464
Practice Address - Country:US
Practice Address - Phone:920-606-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician